Minnesota PAs Look to the Future

Tomasz onierek/123RF.com

Physician Assitants all across the country are talking about Minnesota. Why? Because with the passing of the PA Modernization Act, the Gopher state takes an extraordinary leap into the future of affordable and accessible healthcare.

Physician Assistants, or PAs, are an essential element of our healthcare system. With no end in sight to the perpetual physician shortage, PAs care for America’s most vulnerable patients and in some of the most rural places. They practice in primary care, surgery, and everywhere in between. But as the era of privately owned physician practices all but comes to an end, PAs feel the need to evolve.

The End of Private Practice

50 years ago, when the PA profession was conceived, most physicians were self-employed. Today, these entrepreneurial doctors are a minority. Increasing bureaucracy and diminishing reimbursement have pushed physicians to increasingly become hospital employees. As this has occurred, the motivation and incentive to collaborate with a PA have greatly diminished.

When PAs were a relatively new concept, and physicians were the sole gateway to healthcare, supervision and collaboration laws were created to protect public safety. Over the last 50 years, however, multiple studies and millions of patients affirm that PAs add value and improve access to quality care.

The Autonomous PA

Why is the concept of supervision now more of a burden than a blessing? One reason is that PA supervision is largely retrospective. For many, it’s more of an after-thought and done begrudgingly to remain in compliance. If charts are reviewed at all, it occurs some time after the PA has made and executed decisions regarding a patient’s care. How does this improve patient safety? And why is the physician still seen as liable for those decisions?

PAs collaborate with physicians when appropriate. As a primary care provider, I consult with specialists when indicated. I’m lucky enough to share an office with an excellent MD. The proximity allows us to discuss cases frequently and learn together. The diagnoses I make are still mine, however, and they are made without anyone looking over my shoulder.

This idea of PAs as dependent providers negatively affects access to care. PAs can manage an insulin pump, for example, but they’re not able to prescribe diabetic shoes. In the state where I practice, if a physician were to lose his job, so would the PA he supervises.

A Wave Sweeping the Nation

Legislators across the country are recognizing that statutes from a bygone era need to be revisited. Those that no longer serve a purpose should be repealed and replaced. Healthcare providers already spend an inordinate amount of time navigating a sea of red tape with prior authorizations, appeals, and compliance--the administrative burden created by outdated policies only adds to this burden. In the end, it’s the patients that suffer.

But thanks to S.F. 13, that’s about to change--at least in Minnesota. The PA Practice Modernization Act, as it’s come to be called, addresses the very core of the issue--the requirement that a PA’s license to practice medicine is tied to a specific physician. No other healthcare provider is statutorily dependent on another, and now in Minnesota, PAs aren’t either.

The PA Practice Modernization Act also eliminates the delegation agreement that formed the basis of the PA-physician relationship. A PA’s scope of practice is now established according to each individual PA’s education, experience, and training. This determination will be made at the practice level rather than being rigidly dictated by the state. In a similar vein, a PA’s authority to prescribe medication is now protected in statute rather than being considered a delegated duty.

Team-Based Care Continues

Even with the passing of S.F. 13, PAs will continue to work closely with physicians. Proponents of these updates are quick to dismiss the bill as an attempt to win independent practice. A review of the practice agreement must be completed annually by a licensed physician, but otherwise, there is no implication of liability on the part of said physician.

The bill also makes no attempt to change the way PAs are licensed or regulated in the state, and this will continue to be handled by the Minnesota Board of Medical Practice. It also makes no changes to the educational or certification standards required to practice. And even though PAs will no longer require a physician to go on record as their “supervisor,” some third-party payers, including Medicare and Medicaid, may continue to require it for credentialing purposes.

How does this affect PA employment in the state? For one, PAs will now be more attractive candidates where they had been losing ground relative to NPs (nurse practitioners), who after 2,080 hours, graduate to full independent practice authority. Those working to recruit PAs in Minnesota will need to understand these changes and educate hiring authorities on the streamlined process.

The bill goes into effect on August 1st, 2020.